Cytotoxicity and biocompatibility of a new bioceramic endodontic sealer containing calcium hydroxide

Abstract: This study evaluated the cytotoxicity and biocompatibility of a new bioceramic endodontic sealer (i.e., Sealer Plus BC) in comparison with those of MTA Fillapex and AH Plus. L929 fibroblasts were cultured and Alamar Blue was used to evaluate cell viability of diluted extracts (1:50, 1:100, and 1:200) from each sealer at 24 h. Polyethylene tubes that were filled with material or empty (as a control) were implanted in the subcutaneous tissue of rats. The rats were killed after 7 and 30 d (n = 8), and the tubes were removed for histological analysis. Parametric data was analyzed using a one-way ANOVA test, and nonparametric data was analyzed via the Kruskal-Wallis test followed by the Dunn test (p < 0.05). A reduction in cell viability was observed in the extracts that were more diluted for Sealer Plus BC when compared to that of Control and AH Plus (p < 0.05). However, the 1:50 dilution of the Sealer Plus BC was similar to that of the Control (p > 0.05). Conversely, more diluted extracts of MTA Fillapex (1:200) and AH Plus (1:100 and 1:200) were similar to the Control (p > 0.05). Histological analysis performed at 7 d did not indicate any significant difference between tissue response for all materials, and the fibrous capsule was thick (p > 0.05). At 30 d, Sealer Plus BC was similar to the Control (p > 0.05) and MTA Fillapex and AH Plus exhibited greater inflammation than the Control (p < 0.05). The fibrous capsule was thin for the Control and for most specimens of Sealer Plus BC and AH Plus. Thus, Sealer Plus BC is biocompatible when compared to MTA Fillapex and AH Plus, and it is less cytotoxic when less-diluted extracts are used.

Omega 3 fatty acids reduce the triglyceride levels in rats with apical periodontitis

Abstract The aim of this study was to evaluate the influence of the prophylactic and therapeutic supplementation with omega 3 polyunsaturated fatty acids (w-3 PUFAs) on the lipid profile and periapical bone resorption in rats with apical periodontitis. Forty male rats were divided into groups: control rats (C), rats treated with w-3 PUFAs (C+O), rats with pulp exposure-induced apical periodontitis (AP), and rats with AP treated with w-3 PUFAs (AP+O). The administration of w-3 PUFAs was carried out orally once a day for 15 days before pulp exposure and, subsequently, for an additional 30 days after pulp exposure. AP was induced by exposing pulpal tissues to the oral environment. The samples were collected after 30 days. Triglycerides and cholesterol levels were enzymatically measured using the Trinder method. The jaws were collected and submitted for histological analysis. Two-way analysis of variance and Kruskal-Wallis tests were used for statistical analysis, and the significance was set at p<0.05. The triglyceride levels of the AP group were significantly higher than those of the C, C+O and AP+O groups (p<0.05). However, the difference in the cholesterol levels among the groups was not significant (p>0.05). Rats with AP showed larger areas of bone resorption as well as higher inflammatory intensity compared with rats with AP supplemented with w-3 PUFAs. It may be concluded that the presence of multiple AP foci increased the triglyceride levels. In addition, omega 3 supplementation might reduce these levels in rats with AP, as well as the bone resorption areas of periapical tissues.

Resumo O objetivo deste estudo foi avaliar a influência da suplementação profilática e terapêutica com os ácidos graxos ômega-3 no perfil lipídico e na reabsorção óssea, em ratos com periodontite apical. Quarenta ratos machos foram divididos em grupos: ratos controle (C), ratos tratados com ácidos graxos ômega-3 (C+O), ratos com periodontite apical induzida por meio de exposição pulpar (PA), ratos com PA tratados com ácidos graxos ômega-3 (PA+O). A administração do ômega-3 foi realizada oralmente, uma vez ao dia durante 15 antes da exposição pulpar e, subsequentemente, por mais 30 dias depois da exposição pulpar. A PA foi induzida por meio da exposição do tecido pulpar ao ambiente oral. Após 30 dias, os ratos foram mortos e os níveis de triglicérides e colesterol foram mensurados pelo método enzimático de Trinder. As mandíbulas foram coletadas e submetidas à análise histológica. Análise de variância de dois fatores e teste de Kruskal-Wallis foram utilizados para análise estatística, e o nível de significância foi de p < 0,05. Os níveis de triglicérides do grupo PA foram significativamente maiores que dos grupos C, C+O e PA+O (p<0,05). Entretanto, não houve diferença significativa nos níveis de colesterol entre os grupos (p>0,05). Ratos com PA apresentaram maior área de reabsorção óssea bem como maior intensidade no infiltrado inflamatório comparados aos ratos com PA suplementados com ômega-3. Pode-se concluir que a presença de múltiplos focos de PA aumentou os níveis de triglicérides. Além disso, a suplementação com ômega-3 pode reduzir estes níveis em ratos com PA, bem como a área de reabsorção óssea dos tecidos periapicais.

Endodontic medicine: interrelationships among apical periodontitis, systemic disorders, and tissue responses of dental materials

Abstract: Endodontic medicine, which addresses the bidirectional relationship between endodontic infections and systemic diseases, has gained prominence in the field of endodontics. There is much evidence showing that while systemic disease may influence the pathogenesis of endodontic infection, endodontic infection can also cause systemic alterations. These alterations include more severe bone resorption and inflammation in the periapical area as well as enhanced systemic disease symptoms. Similarly, many reports have described the impact of systemic diseases on the tissue responses to dental materials. Conversely, the local use of dental materials may show systemic effects in the form of altered production of biomarkers. Thus, studies to better understand the mechanisms related to those connections are extremely important. In this context, the objective of this review was to analyze and discuss the current literature regarding the connections among these three factors—systemic diseases, endodontic infection, and endodontic dental materials—and determine how these connections may interfere in the systemic health status and the endodontic treatment outcomes, which are represented by periapical wound healing.

Influência local e sistêmica da suplementação alimentar com os ácidos graxos ômega-3 em ratos com infecção endodôntica / Local and systemic influence of the dietary supplement with omega 3 fatty acids in rats with endodontic infection

O objetivo deste trabalho foi avaliar a influência da suplementação alimentar com os ácidos graxos ômega-3 no processo inflamatório local e sistêmico de ratos com periodontite apical (PA). Foram utilizados 40 ratos da linhagem Wistar distribuídos em quatro grupos (n= 10): ratos controle (C); ratos suplementados com ômega-3 (C-O); ratos com PA induzida (PA); ratos com PA induzida suplementados com ômega-3 (PA-O). Para a indução da PA, as polpas dentárias foram expostas ao meio bucal durante 30 dias. O ômega-3 foi administrado pelo método gavage, uma vez ao dia, 15 dias antes da exposição pulpar e 30 dias depois da exposição pulpar. Após este período, o sangue foi coletado, por meio de punção cardíaca, para a realização do hemograma e quantificação sérica das citocinas pró-inflamatórias fator de necrose tumoral alfa (TNF-a), Interleucina 6 (IL-6) e Interleucina 17 (IL-17), pelo método ELISA. Após a coleta sanguínea, os ratos foram eutanasiados e as maxilas e mandíbulas foram coletadas e submetidas a processamento para análise histológica, em hematoxilina e eosina, bem como análise imunoistoquímica para os marcadores fosfatase ácida resistente ao tartrato (TRAP), osteocalcina (OCN), TNF-a, IL-6, IL-17, Interleucina 1b (IL-1b) e Interleucina 10 (IL-10). Os resultados foram analisados por testes estatísticos específicos para cada caso (p<0,05). O grupo PA apresentou infiltrado inflamatório mais intenso, bem como maior área de reabsorção óssea na região periapical quando comparado ao grupo PA-O (p<0,05). Além disso, observou-se maior número de osteoclastos e citocinas pró-inflamatórias, representadas por TNF-a, IL-1b, IL-6 e IL-17, bem como menor número de osteoblastos e da citocina anti-inflamatória IL-10 no grupo PA quando comparado ao grupo PA-O (p<0,05). Em relação às alterações sistêmicas, a presença de quatro focos de PA aumentou os níveis séricos de leucócitos, linfócitos, monócitos, TNF-a e IL-6 (p<0,05) e a suplementação alimentar com os ácidos graxos ômega-3 diminuiu os níveis séricos de leucócitos e linfócitos de ratos com PA (p<0,05). Conclui-se que a suplementação alimentar com os ácidos graxos ômega-3 reduz o processo inflamatório e a reabsorção óssea da região periapical, bem como as células inflamatórias do sangue, de ratos com infecção endodôntica(AU)

The aim of this study was to evaluate the effects of the dietary supplement omega 3 polyunsaturated fatty acids on the local and systemic inflammatory response of rats with apical periodontitis (AP). Forty male rats were divided into groups: control untreated rats (C), control rats treated with omega 3 alone (CO), rats with pulp exposure-induced apical periodontitis (AP), and rats with pulp exposure-induced AP treated with omega 3 (AP-O). The pulps were exposed to the oral environment during 30 days for the development of AP. Omega 3 was administered by gavage method, once a day, for 15 days before pulp exposure and, subsequently, 30 days after pulp exposure. After 30 days, blood samples were collected by cardiac puncture and subjected to blood count and the serum levels of the proinflammatory cytokines tumor necrosis factor alpha (TNF-a), Interleukin 6 (IL-6), and Interleukin 17 (IL-17) were measured using ELISA method. Subsequently, rats were killed and maxillae and jaws were collected and subjected to histologic analysis, using hematoxylin and eosin staining. Immunohistochemistry was performed in order to detect TRAP-positive osteoclast cells (TRAP), Osteocalcin-positive osteoblasts cells (OCN), TNF-a, IL-6, IL-17, Interleukin 1b (IL-1b) and Interleukin 10 (IL-10). Results from the different analysis were subjected to statistical analysis, using specific statistical methods according to each analysis (p<0.05). AP group showed more severe inflammatory infiltrate as well as higher area of bone resorption in the periapical region compared to AP-O group (p<0.05). Moreover, the number of TRAPpositive cells as well as proinflammatory cytokines, such as TNF-a, IL-1b, IL-6, and IL-17 were higher in AP group compared to AP-O group (p <0.05). In addition, the number of OCN-positive cells and the anti-inflammatory cytokine IL-10 decreased in AP group compared to AP-O group (p<0.05). Regarding systemic alterations, the presence of four AP focus increased the serum levels of leukocytes, lymphocytes, monocytes, TNF-a, and IL-6 (p<0.05). The dietary supplement with omega 3 decreased the serum levels of leukocytes and lymphocytes of rats with AP (p<0.05). It may be concluded that the dietary supplement with omega 3 fatty acids decrease the inflammatory process and the pathological bone resorption in the periapical region, as well as serum inflammatory cells of rats with apical periodontitis(AU)

Influência da infecção endodôntica associada ou não à diabetes nos níveis da citocina pró-inflamatória IL-17 nos tecidos periapical, hepático e renal de ratos Wistar / Influence of endodontic infection with or without diabetes in the levels of proinflammatory cytokine IL-17 in periapical, hepatic and renal tissues of Wistar rats

O objetivo deste trabalho foi avaliar a influência da infecção endodôntica associada ou não à diabetes, nos níveis da citocina pró-inflamatória IL-17, nos tecidos periapical, hepático e renal de ratos Wistar. Foram utilizados 40 ratos machos divididos em quatro grupos contendo 10 animais cada grupo: ratos normoglicêmicos (N); ratos normoglicêmicos com periodontite apical (N-PA); ratos com diabetes experimental (DE); ratos com diabetes experimental e com periodontite apical (DE-PA). A diabetes foi induzida por meio da administração de estreptozotocina via veia peniana. Foi realizada avaliação glicêmica, para confirmar o desenvolvimento da doença, no sexto e no último dia do experimento. A infecção endodôntica foi induzida por meio da exposição pulpar do primeiro molar superior direito ao meio bucal. Após 30 dias, foram coletados o fígado e o rim, para a quantificação da IL-17 pelo método ELISA, bem como a hemi-maxila direita para a quantificação da IL-17 pela técnica imunoistoquímica. Os valores obtidos nos testes paramétricos foram tabulados e analisados, estatisticamente, por meio dos testes de análise de variância (ANOVA) e teste de Tukey (p<0,05). Os valores obtidos em scores foram analisados, estatisticamente, por meio dos testes de Kruskal-Wallis e teste de Dun (p<0,05). Os resultados mostraram que os ratos diabéticos (DE e DE-PA) apresentaram maior quantidade de IL-17 nos tecidos hepático e renal quando comparados aos ratos normoglicêmicos (N e N-PA) (p<0,05). A análise histológica mostrou que a periodontite apical de ratos diabéticos (DE-PA) possui maior severidade quando comparada com a dos ratos normoglicêmicos (N-PA) (p<0,05), além disso, houve um aumento significativo dos níveis de IL-17 na periodontite apical dos ratos diabéticos (DE-PA) quando comparados aos normoglicêmicos (N-PA) (p<0,05). Entretanto, a infecção endodôntica induzida em um único elemento dentário não foi capaz de alterar os níveis de IL-17 nos tecidos hepático e renal (p>0,05)...

The aim of this study was to evaluate the influence of endodontic infection with or without diabetes, in the levels of proinflammatory cytokine IL-17 in apical periodontitis and hepatic and renal tissues of Wistar rats. Forty male Wistar rats were divided into four groups of ten animals each: normoglycemic rats (N), normoglycemic rats with apical periodontitis (N-AP), rats with experimental diabetes (ED), rats with experimental diabetes and apical periodontitis (ED-AP). Diabetes was induced by injection of streptozotocin in the penile vein. Glycemic control was performed to confirm the development of the disease at the sixth and last day of the experimental period. The endodontic infection was induced by exposure of the upper right first molar to the oral environment. After 30 days, the hepatic and renal tissues were collected for the IL-17 quantification by ELISA, as well the right hemi-jaw for the IL-17 quantification by immunohistochemistry. The values obtained in parametric tests were tabulated and analyzed statistically by means of analysis of variance tests (ANOVA) and Tukey test (p<0.05). The values obtained for scores were statistically analyzed by Kruskal-Wallis and Dun test (p<0.05). The results showed that diabetic rats (ED and ED-AP) showed a higher IL-17 levels in the hepatic and renal tissues compared to normoglycemic rats (N and N-AP) (p<0.05). The apical periodontitis in diabetic rats (ED-AP) had higher severity when compared to normoglycemic rats (N-PA) (p<0.05), furthermore, there was a large increase in IL-17 levels in apical periodontitis of diabetics rats (ED-AP) when compared with normoglycemic rats (N-AP) (p<0.05). However, the induced endodontic infection did not alter IL-17 levels in hepatic and renal tissues (p>0.05). It may be concluded that diabetes increases IL-17 levels in hepatic and renal tissues, as well as enhances the IL-17 production in apical periodontitis. Diabetes also increases the severity and development of apical...

Root Reconstructed with Mineral Trioxide Aggregate and Guided Tissue Regeneration in Apical Surgery: A 5-year Follow-up

Apical surgery should be considered as the last treatment option and employed when conventional endodontic treatment does not provide the expected result. In teeth undergoing apical surgery, the type of retrograde filling material is one of the factors interfering with the repair of periapical tissues. The material in intimate contact with the periapical tissues plays a fundamental role in the repair process. Several materials have been studied and indicated for use in apical surgery procedures, but the mineral trioxide aggregate (MTA) is still the most frequently used one. Guided tissue regeneration (GTR) techniques have been proposed as an adjunct to apical surgery to enhance bone healing. Here is reported a clinical case in which apical surgery was performed in conjunction with MTA-based root reconstruction of the maxillary right second incisor. After the apical surgery, a root-end cavity was prepared at the vestibular face of the involved tooth and filled with MTA. A bovine bone graft and a cortical collagen membrane were placed on the bone defect. After 5 years, clinical and radiographic assessments showed that the treatment was successful. It may be concluded that MTA presents favorable characteristics in adverse conditions and can be used in conjunction with GTR in cases involving root reconstruction.

A cirurgia apical deve ser considerada como a última opção de tratamento, e realizada quando o tratamento endodôntico convencional não proporciona o resultado esperado. Em dentes submetidos à cirurgia apical, o tipo de material retro-obturador é um dos fatores que interferem no reparo dos tecidos periapicais. O material em íntimo contato com os tecidos periapicais desempenha um papel fundamental no processo de reparo. Vários materiais têm sido estudados e indicados para o uso em procedimentos de cirurgias apicais, entretanto o agregado de trióxido mineral (MTA) ainda é o mais frequentemente utilizado. A regeneração tecidual guiada (GTR) tem sido proposta como um auxiliar na cirurgia apical para melhorar a formação óssea. Aqui é relatado um caso clínico em que a cirurgia apical foi realizada em conjunto com a reconstrução radicular do incisivo lateral superior esquerdo com MTA. Após a cirurgia apical, foi preparada uma retro-cavidade na parede vestibular e o dente envolvido foi obturado com MTA. Um enxerto de osso bovino e uma membrana de colágeno cortical foram colocados no defeito ósseo. Após 5 anos, avaliações clínica e radiográfica mostram que o tratamento foi bem sucedido. Pode-se concluir que o MTA apresenta características favoráveis em condições adversas e que pode ser usado em conjunto com GTR em casos envolvendo reconstrução radicular.